Objective: to study the motor-evacuation function of the gastrointestinal tract in chronic duodenal stasis and the conjugation of their disorders with excessive bacterial growth.

Materials and methods. Thirty patients with chronic duodenostasis (DS) aged 37.1 ± 13.8 years were examined. Anamnestic and physical data, results of X-ray and endoscopic examinations, intracavitarymanometry were used in the verification of DS. The determination of excess bacterial growth (IDB) in the small intestine was carried out by analyzing the results of the hydrogen respiratory test (VDT). The assessment of the motor function of the stomach and duodenum was carried out using the gastroenteromanometer GEM-01 “Gastroskan-GEM”. For conducting short-term pH-measurement, the Gastroskan-5M device was used.

Results. All patients with DS presented dyspeptic complaints, revealed asthenic syndrome. In the postprandial period, impaired propulsive motility in all sections of the digestive tube was also expressed, which proves a 1.5-fold decrease in fasting urea, jejunum and ileum by 1.5 times in both phases of the study (p& <0.001). In patients with DS, IDB was detected in 22 (78.6%) cases. Among all examined patients in 19 (67.9%) patients, IDB was associated with increased bacterial activity in the small intestine. Colon dysbiosis was detected in 3 (10.7%) patients (χ2 = 7.093, p = 0.008). A correlation analysis between the hydrogen content in exhaled air and the rhythmic coefficient of the large intestine showed a reliable strong feedback (r& = 0.65, p = 0.015).

Conclusion. A comprehensive study of the motor-evacuation function of the digestive system and the state of enteric microbiocenosis expands the possibilities of pathogenetically substantiated therapy for diseases of the organs of the gastroduodenobiliary pancreatic zone.

The aim. Assessment of the relationship between the occurrence of endotoxemia and impaired resorption function of the small intestine, arrhythmia of the motility of the stomach and intestines, and excessive bacterial growth in the metabolic syndrome (MS).

Materials and methods. 62 patients with MS were examined. The average age was 48.62+3.75 years. The motor function of the gastrointestinal tract was studied using peripheral electrogastroenterocolography. To assess the absorption processes in the small intestine, stress tests with glucose and d-xylose were used. Blood endotoxin level, quantitative and& qualitative composition of parietal microbiota of small intestine were determined using an Agilent gas chromatograph with mass-selective and flame-ionization detectors (Agilent Technologies, USA).

Results. 82.9% of the examined patients with MS showed clinical signs of intestinal damage. The electrical activity of& the& small intestine departments in the postprandial period was low in 70% of patients. The electrical activity of& the& colon on an empty stomach was not changed, and after a food load was reduced. Discoordination of motility is observed between small intestine and the colon, aggravated after food stimulation. A significant decrease in the rhythm of contractions is observed at the frequencies of the jejunum, ileum, and colon both on an empty stomach and in the postprandial period, which indicates a weakening of propulsive bowel contractions in patients with MS. In patients with MS, an increase in& the& absorption of glucose and d-xylose was revealed in comparison with the group of healthy individuals. In patients with MS, excessive bacterial growth in small intestine is observed mainly due to conditionally pathogenic microbiota strains. According to the results of the study of blood endotoxin level in patients with MS, a significant increase was revealed in comparison with the control group. Correlation analysis showed a moderate negative relationship between the level of endotoxin and electrical activity of small intestine, between the level of endotoxin and the ratio of the ratio of& the& colon to the ileum. A moderate positive relationship was established between the degree of endotoxemia increase and glucose absorption in small intestine.

Conclusion. A study of the level of endotoxin and indicators of excessive bacterial growth, motor evacuation and resorption functions of small intestine revealed important pathogenetic patterns regarding the contributing role of the latter in& the development of endotoxemia in patients with MS.

The aim. To study the influence of anthropometric indicators on the results of a drinking test with water of different temperatures, as well as on the psycho-emotional status.

Materials and methods. The study involved 36 students. Conducted: measurement and calculation of basic anthropometric indicators, psychological testing using questionnaires, fasting drinking test with still water of different temperatures for four days with fixing the volume of liquids drunk. All examined students are divided into two groups according to the results of anthropometric examination.

Results. The prevalence of overweight among students was 25,0%. Studies have shown the relationship between the main anthropometric indicators, the amount of fluid drunk and the temperature of the water taken, which indicate a violation of the relaxation accommodation of the stomach in individuals with a large amount of adipose tissue and% relative fat content. An increase in visceral hypersensitivity and a progressive deterioration of the relaxation accommodation of the stomach with an increase in the temperature of the received water were established. As a result of the work done, it was found that with an increase in BMI, a deterioration in well-being, an increase in depression, situational and personal anxiety and neurotization are observed. Overweight students with an increase in the volume and mass of total adipose tissue have a deterioration in mood and a greater tendency to depression. It was also proved the presence of a pronounced positive effect of drinking water on the human body with excess body weight, including its psychoemotional state.

Conclusion. The results obtained make it possible to form anthropometric images of a person predisposed to disturbed accommodation of the stomach, taking into account gender, body weight and the nature of the distribution of adipose tissue. These studies confirmed a change in psychoemotional status depending on the main anthropometric indicators. The corrected effect of fasting drinking room-temperature water (30 °C) on the psycho-emotional state of overweight people is shown.

Objective of the study: to clarify the influence of external factors on the symptoms of functional dyspepsia in medical students.

Materials and methods: A survey of 105 students aged 20.2 ± 0.18 years was conducted. The survey was conducted on a special gastroenterological questionnaire GSRS. Also in the questionnaire we added questions that characterize postprandial distress syndrome. An additional questionnaire was conducted on issues that allow us to assess the influence of external factors on the functional dyspepsia of students (nutrition, bad habits, constitutional features).

Results: During the study revealed: the intensity of manifestations of functional dyspepsia from 1 to 6 courses is reduced. Bad habits like smoking, eating at bedtime, using chewing gum, eating with alcohol have a negative effect on the digestive system, which can be a risk factor for developing functional dyspepsia. A correlation was also found between clinical syndromes: epigastric pain syndrome and reflux syndrome (r = 0.4), diarrhea syndrome (0.37), dyspeptic syndrome (0.5), constipation syndrome (0.37); postprandial distress syndrome and reflux syndrome (0.42), diarrhea syndrome (0.39), dyspeptic syndrome (0.83), constipation syndrome (0.39).

Conclusions: The intensity of most manifestations of functional dyspepsia during the transition to older courses decreases, however, 4-year students are more susceptible to postprandial distress syndrome, which can be associated with adverse factors such as smoking, eating food at bedtime, using chewing gum, eating with alcohol.

The aim of the study was to evaluate the effectiveness of ursodeoxycholic acid (UDCA) in combination with ProbioLog at the early stage of gallstone disease in the elderly.

Material and methods: 92 patients with early stage of cholelithiasis (CL) were examined, the average age was 66,69 ± 5,52 years, there were 29 men and 63 women. In addition to anamnestic and general clinical data, the results of ultrasound examination (US) of the gallbladder were used to verify the diagnosis. The biochemical properties of bile (cholesterol, bile acids, phospholipids levels, bile lithogenicity indices) were studied. The composition of the intestinal microflora was determined using a hydrogen breath test with lactulose and culture of feces for dysbiosis. Two groups were formed due to the course of treatment, which amounted to 30 days. 45 patients of the observation group received UDCA 15 mg / kg per day once for a night in combination with the probiotic ProbioLog (Mayoly Spindler, France), 1 сapsule twice per day. UDCA monotherapy of 15 mg / kg daily was administered to 47 patients of the comparison group once for the night.

Results. After the course of treatment, a favorable dynamics of clinical symptoms of the disease was noted. According to US, elimination of biliary sludge was observed in 62.2% of patients of the observation group and in 14.8% of patients of the comparison group. An improvement in the biochemical composition of bile was manifested by decreasing of its lithogenic properties. The important results of therapy were positive changes in the composition of the intestinal microflora, contributing to the normalization of the exchange of bile acids, cholesterol and phospholipids.

Conclusion. The combined using of UDCA and ProbioLog in elderly patients is clinically effective in the treatment of early stages of cholelithiasis and pathogenetically justified in the prevention of gallstone formation.

The constant increase in the incidence of diabetes in the world and the high frequency of lesions of the upper gastrointestinal tract with impaired motor function in this category of patients, on the one hand, worsen the clinical picture, and on the other, reduce the effectiveness of sugar-lowering therapy. Currently, specialists have at their disposal a number of prokinetics that contribute to the restoration of the motor-evacuation function of the stomach, but many of them have many undesirable effects. The aim of our study was to evaluate the effectiveness of itopride hydrochloride in the treatment of patients with chronic gastritis associated with Helicobacter pylori and type 2 diabetes. During the study, both general clinical and more specific research methods were used, in particular, esophagogastroduodenoscopy. According to the results of the study, the use of prokinetics in the treatment of patients with type 2 diabetes mellitus reduces the manifestations of impaired motor-evacuation function of the upper gastrointestinal tract. The results obtained indicate to verify the manifestations of chronic gastritis in patients with type 2 diabetes mellitus and the identification of motor dysfunction and the need for prokinetic therapy.

Objective: to evaluate the therapeutic efficacy of the combined use of ursodeoxycholic acid and atorvastatin in non-alcoholic fatty liver disease (NAFLD) with concomitant atherogenic dyslipidemia.

Materials and methods.123 patients with NAFLD at the stage of steatosis were examined, among them 66 women and 57 men aged 30 to 70 years. In verification of NAFLD, an ultrasound examination (ultrasound) of the hepatobiliary system was used using the SONIX OP apparatus (Canada). To exclude fibrosis in the liver parenchyma, sonoelastographywas performed on an AIXPLORER apparatus (France) and the FibroTest and FibroMax tests developed by BioPredictiv (Paris, France) were used. The lipid profile was determined on an analyzer FP-901 (M) from Labsystems (Finland) (Spain, Barcelona). The method of multifractional (5-phase) duodenal sounding (MFDZ) was used, which makes it possible to evaluate bile indices (cholesterol and bile acids).

Results. Ultrasound of the liver and SteatoTest revealed steatosis in all patients with NAFLD. The examined identified signs of atherogenic dyslipidemia. There was a significant increase in cholesterol in portions “B” and “C” of bile (by 79.9% (p = 0.001) and 76.89% (p = 0.001), respectively), a decrease in the amount of bile acids in portions “B” and “ C ”bile (by 46.74% (p = 0.001) and 30.56% (p = 0.1), respectively). A sharp decrease in the cholecholesterol coefficient (by 90.55% (p = 0.001) and 86.03% (p = 0.01), respectively) confirms the high lithogenic properties of bile. The combined use of ursodeoxycholic acid (UDCA), simultaneously with atorvastatin, manifested a more pronounced both lipid-lowering effect and correction of the lithogenic properties of bile, in comparison with UDCA monotherapy.

Conclusion. The effectiveness of the course application of UDCA in combination with atorvastatin in the correction of hyper- and dyslipidemia and biochemical parameters of bile in patients with NAFLD at an early stage of steatosis was determined.

The purpose of the research is to study the informativeness of the technology of Controlled Attenuation Parameter (CAP) in Shear Wave Elastography (SWE) in determining the degree of severity of liver steatosis depending on the elastometric quantitative values of liver fibrosis in a one-time study in a given volume of parenchima liver in patients with non-alcoholic fatty liver disease (NAFLD).

Materials and methods of research. The study included 169 patients with NHTSA between the ages of 19 and 81, the average age was 41.7 ±11.3 years, examined in the “City Clinical Hospital No. 1” of the Ministry of Health, Chuvashia (Cheboksary, Russia). Patients with functional disorders of bile evacuation (n= 72) were the first group; the 2nd group were the patients with liver steatosis without manifestations of liver fibrosis (n = 28); the 3rd contained the patients with cirrhosis of the liver (n = 25); patients with chronic viral hepatitis B and C (n= 44) were in the 4^th group. All patients were screened with ultrasonic shear wave elastography with elastometry in one-dimensional (TE) (FibroScan 502 TOUCH, France) and two dimensional (2DSWE) modes (Aixplorer, Supersonic Imagine, France). Elastometry (kPa) and steatometry (dB/m) were completed simultaneously within the same volume of the analyzed liver tissue with two sensing devices of “FibroScan 502 TOUCH”. The statistical processing was carried out with the help of IBM SPSS Statistics 10.0. The results are reflected in the form of median (Me), minimum (min), maximum (max) and medium (Emean) values, standard deviation (SD) of Jung’s elasticity module. Correlational analysis of the received values of parameters F and S was made with the descriptive method of Bland-Altman and the method of Spearman.

Results and discussion. The average quantitative values of the severity of liver steatosis in patients with cirrhosis of liver had reliably lower values (234.5±62.1 dB/m) than in those suffering from steatosis of the liver without fibrosis (347.5±37.6 dB/m) and patients with chronic viral hepatitis (245.9±57.3dB/m, p lt; 0.001). The values of fibrosis in the same amount of the tested liver tissue with liver cirrhosis (45.5± 22.3 kP) were higher than similar rates in the other groups of patients with NAFLD (p lt; 0.001). Diagnostic informational content of the method of controlled ultrasound attenuation in establishing the degree of manifestation of liver steatosis had a higher specificity with II degree of liver steatosis (99.29% with a sensitivity of 84.92%).

The results of the study allow us to recommend ultrasound elastography with the technology of controlled ultrasound attenuation to determine the severity of liver steatosis for both primary diagnosis and for dynamic monitoring of the liver condition of patients with NAFLD.

The portal vein thrombosis (PVT) is a partial or complete occlusion of blood flow through the portal vein that occurs due to the presence of a blood clot in its lumen. Currently, PVT has become more common in the clinic of internal diseases. PVT can be caused by many factors, among which local and systemic. Systemic factors include congenital and acquired thrombophilia. Local factors include inflammatory, infectious, and oncological diseases of the abdominal organs. One of the most likely causes of PVT is currently being considered liver cirrhosis. The article presents the literature data, clinical guidelines for managing patients with PVT in the discussion of three own clinical cases of patients with PVT, which were caused by various diseases.

The purpose of the study was to assess the state of the pancreas in children, taking into account the indicators of pancreatic elastase of blood serum and feces.

Materials and methods. A study of pancreatic elastase was carried out in 115 children aged 7-15 years with combined gastroduodenal and biliary pathology.

Results. In a comprehensive assessment of the structural and functional state of the pancreas, it was found that in 26.5% of cases there were functional and 45.2% structural changes: chronic pancreatitis - 9.6% of patients, recurrent pancreatitis - 9.9%, reactive pancreatitis - 25.7% of children, dysfunctional disorders - 26.5% of patients. Findings. The studied method has 100% sensitivity and 98% specificity in the differential diagnosis of functional and structural changes in the pancreas. The coprological test allows a quantitative determination of the elastase-1 level, reflecting the degree of pancreatic insufficiency.

Conclusion. Using this test for quantitative determination in serum provides an opportunity to assess the level of enzymemia in reactive pancreatitis. In accordance with modern concepts, pancreatic elastase can be considered as the “gold standard” for diagnosing chronic pancreatitis, a marker for the exocrine function of the pancreatic gland (scatological test) and as an indicator of reactive pancreatitis (definition of serum elastase-1).

Community-acquired pneumonia is currently one of the most common infectious diseases in the world. At the same time, the inflammation that occurs in community-acquired pneumonia, along with hypoxia, is one of the typical pathological processes that is associated with the introduction of an infecting agent. Under its influence, lipid peroxidation is activated through a cascade of reactions, which contributes to the formation of oxidative stress, accompanied by damage to the structures of various cells, including hepatocytes. The purpose of the study: to evaluate the clinical and functional state of the liver in the treatment of community-acquired pneumonia. Materials and methods: There were 120 people under observation, who were divided into 2 groups, receiving standard therapy for community-acquired pneumonia and patients receiving additional meglumin sodium succinate. The clinical and functional state of the liver was analyzed. Conclusions: when adding meglumin sodium succinate to the treatment of community-acquired pneumonia, the clinical and functional state of the liver in patients improves.

Gastric cancer is the leading cause of death among all cancer deaths. Identification of risk groups and special carcinogens will prevent the development of the tumor or detect it in the early stages, which will significantly increase the quality of life of patients with high risks of developing gastric cancer. For the timely detection of tumor development, it is optimal to use systematic screening. Undoubtedly, the approaches to the diagnosis of cancer have significant differences in the countries of the West and the East.

Basis. The problem of multimorbidity and related polypragmasia is highly relevant for health practitioners. Providing treatment a doctor should keep in mind itsall possible negative consequences that might exacerbate other diseases. One of the most current problems of modern pharmacotherapy is the development of gastropatia and other gastrointestinal lesions because of drug intake. It is extremely important for rheumatologic patients, especially elderly ones, due to side effects of nonsteroidal anti-inflammatory drugs and glucocorticoids. Reasonable approach to the prescription of this therapy and side effects prevention is a significant factor of the preventive work of the therapist and the general practitioner of the outpatient service. In patients with rheumatic polymyalgia we showed an approach to long-term treatment of corticosteroids in elderly patients, the aim of which is to achieve a stable remission of the disease and to minimize the undesirable effect of the medication on the gastrointestinal tract.

Aim. Provide an algorithm for the approach to identifying the risk factors of medicinal gastrointestinal lesions and methods for their prevention.

Material and methods. We analyzed literature sources, including Russian guidelines over the last 10 years.

Results. In the article we present an algorithm for detecting the risk of developing gastrointestinal tract lesions against the background of corticosteroid therapy in elderly patients and ways of preventing it.

Conclusion. The prevention of unwanted drug reactions is an important aspect of a doctor’s work, especially in the treatment of elderly patients. The presented algorithm for identification of risk groups and prevention of side effects is intended to help the practical doctor in working with this category of patients.

The aim. Discussion of a clinical case of Crohn’s disease in a patient with chronic kidney disease on program hemodialysis.

Materials and methods: the study analyzed the medical history of a patient diagnosed with Crohn’s disease with severe comorbid pathology.

Results. The provoking factors for the development of Crohn’s disease in a patient with ciliopathy (cystic disease of the kidneys, liver, lungs), ankylosing spondylitis, secondary polyosteoarthrosis, undergoing hemodialysis are discussed.

Aim. The purpose of the article is to study the possibilities of MRI diagnosis of postprandial distress syndrome using the drinking test and its correction with mineral water.

Materials and methods. Clinical observation is described. Patient A., 24 years old, came to the clinic with symptoms of functional dyspepsia. After a comprehensive examination, the diagnosis of Postprandial Distress Syndrome was established. The capabilities of MRI diagnostics of functional dyspepsia were assessed by drinking test. The study lasted 50 minutes. Scans were performed 5, 13, 20, 35 and 50 minutes after water intake. For the next 4 weeks, the patient ingested the non-carbonated mineral water “Uvinskaya” room temperature 30 minutes before taking a meal of 100 ml in the first 6-7 days, followed by an increase in volume to 200 ml 3 times a day.

Results. An MRI study with a drinking test in dynamics showed an increase in the volume of water drunk. When assessing the morphofunctional state of the stomach, differences were revealed at the level of the fundus: before treatment - the wall is tense, after course therapy - relaxed, relaxation accommodation is more pronounced. An acceleration of evacuation of the received water into the duodenum after treatment was also found. The positive dynamics of the state of motor-evacuation function of the stomach is due to the chemical composition of mineral water and the regimen of balneotherapy.

Conclusions. Gastric MRI is an informative and safe diagnostic method for Postprandial Distress Syndrome, which allows to evaluate the structural and functional features of the gastroduodenal zone. Drinking test can help in the MRI diagnosis of functional dyspepsia, increasing the information content of the study. The use of drinking mineral waters in postprandial distress syndrome is pathogenetically justified, but requires further research to develop rational balneotherapy regimens.

The article describes the life, scientific and professional path of a doctor of medical sciences, professor, honored doctor of the Urals and the Russian Federation Y. M. Vakhrushev